Transplantation of composite toe tissues with microsurgical technic has boen performed in 208 patients since Oct. 1979. Among the 242 digits reconstructed, 238 digits (204 patients) were successfully reconstructed and other four digits (4 patitents) failed. The success rate was 98.3%. In this series, 135 cases were loss of thumb, 28 cases loss of fingers, and 45 cases loss of both thumb and fingers. The reconstruction procedures were composed of thumb reconstruction in 166 cases (168 thumbs), finger reconstruction in 28 cases (42 fingers) and both thumb and finger reconstruction in 14 cases (32 digits). The transplantation of second toe were performed in 188 cases and nail-skin flap of great toe transplantation were used in 18 cases. Gilbert Ⅲ variation of the first dorsal metatarsal artery was encountered in 34 donor feet in 30 patients. All these cases were successfully operated upon. A new classification system of thumb loss is proposed. The indication of various operative procedures, different ways of vascular anastomosis, the choice of emergency reconstruction, the use of graft of toe extended with dorsalis pedis flap and the pitfalls of the operation were discussed in detail.

The changes of immunoreactive TRH (TRH-ir) in cerebrospinal fluid (CSF) and plasma before and after acute traumatic head injury were determined with radioimmunoassay (RIA) on a feline model of acute experimental head trauma. The results showed that the concentrations of TRH-ir in experimental animals pre- and 2, 4, and 6h post-injury were 119.48?51.77, 460.71 ?178.72, 377.27? 139.33, and 280.17?110.46pmol/L in CSF, and 122.58?28.87,1158.89?163.18, 909.69?160.55, and 545.38?132.80pmol/L in plasma, respectively, while those in control animals measured at the corresponding time were 112.22?53.42, 105.36?49.64, 100.63?52.89, and 104.52?52.42pmol/L in CSF, and 113.57 ?25.79, 107.32?26.60, 119.84?31.53, and 117.21?28.95pmol/L in plasma, respectively. The contents of TRH-ir in CSF and plasma in the experimental group after traumatic head injury were significantly higher than those, in the control group (P

Military physicians is one of the most important sections of medical service capability since they shoulder the sacred responsibility of healing the wounded and rescuing the dying and maintain and improve the fighting effectiveness of the army. The article analyses the influence of the future limited high-tech war on military medicine and the feature of military service , Based on these materials, Discussion on the military physician's quality of the future limited high tech war has been made.

Objective To describe the method and review the outcome of reconstruction ofⅠandⅡdegree defect of thumb and finger by p artial transplantation of distal to e tissue from the great and /or second toe.Methods A series of 65cases with 71ⅠandⅡdegree thumb and finger defect were r econstructed.Of those,49were thumb defect,12index finger,5middle finger and 5ring fin ger.In 6cases,two digits were reconstructed simultaneously at th e same setting.For thumb reconstruction,the donor transplants were har-vested from great toe in 14cases,fro m 2nd toe in 35cases.All finger recon struction cases were taken from2nd toe.Results Postoperative arterial crisis occu rred in 10digits and venous crisis in4.All digits survived after operative and medication trea tment.Twenty digits underwent seco ndary plastic operation for better c os-metic effect.Forty-two digits in 38cases followed-up from 6months to 13years revealed good pulp pinch function.Sensation recovery to S3 + and above in 30cases(34digits)and two-point discrimination from 6-8mm in 30digits.The patients were satisfied with the appearance of the reconstructed thumb and fingers.There were no major complication in the don or toes.Conclusion The defect of distal segment and finger tip of thumb and /or finger can be reconstru cted by transplantation of partial t issues from the great,2nd or /and 3rd toe.The operation will not be influenced by anomaly of the blood vessels.Both ultimate function and cosmetic effect can meet the patientsdesire.[

Objective To introduce the outcome of compound defect in the hand treated by compound flap transfer or combined flaps transfer. Method From Dec.1983 to June 2001,thirty-five cases with five kinds of compound defect in the hand were treated surgically.Among them,four cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons;Three cases with longitudinal subtotal loss of distal thumb and one case with longitudinal subtotal loss of distal middle finger were reconstructed with fibular segmental osteo-onychocutaneous flap from great toe or tibial segmental osteo-onychocutaneous flap from second toe;Eight cases with total or subtotal defect at middle part of thumb or fingers were reconstructed with segmental second toe; seventeen cases with defect of thumb and hand skin were reconstructed with combined transplantation of second toe and free skin flap;Two cases with middle finger defect at the base of proximal phalanx were reconstructed with bridging transplantation of bilateral second toe. Result Thirty-three cases were successful.Follow-up period ranged from 0.5 to 5 years postoperatively.The excellent and good rate was 82.9% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery. Conclusion The compound flap transfer or combined flaps transfer was an ideal method in repair of compound defect in the hand.

Objective To report the result of bilateral second toes transfer for reconstruction of total hand or total digits defect. Methods A series of 14 total hand or total digits defect were reconstructed by transplantation of 2nd toes from both feet forming a crab-shaped hand. Among 14 cases, 11 cases were males and 3 females. The patients were aged from 4-44 years, with an average of 22.7 years. One of the 14 cases was of congenital deformity and the other 13 were caused by trauma. The 14 cases were classified into three types according to the level of amputation; Type Ⅰ: defect at the distal end of the metacarpal bone with good function of abductor pollicis in 6 cases; Type Ⅱ: at the proximal end of carpus or the level of wrist joint in 5 cases; and type Ⅲ: at the forearm end stump in 3 cases. All the operations were successful. Results All 28 transferred toes survived uneventfully with good blood supply and pulp fullness and elasticity. Follow-up examination made at mean 6.6 years postoperative period (2-15 years) showed that mean total active motion (TAM) of IP joints of reconstructed digit was 57.5? (35?-105?). All the 14 cases had restored digital function, such as opposition of the fingers, pinching a pencil, a key, a needle or holding an ink-bottle. The mean distance between the two reconstructed digital pulps was 4.3 cm (2.6-6.5 cm). Judging by the evaluation standard of British Medical Institute, sensation recovery to S3+ was obtained in 20 digits of 10 cases. Based on the trial criteria of the function of hand reconstruction of hand surgery society of Chinese Medical Association, 2 were assessed as excellent, 7 good, 4 fair and 1 poor. Conclusion Reconstruction of crab-shaped hand for total hand or total digits defect by transfer of bilateral 2nd toes with metatarso-phalangeal joint can give the patient reasonable prehensile function without much impairment to foot function.

Objective To analyze the long- term results of vascularized fibular graft to repair defects of long bone. Methods Nineteen patients undergone vascularized fibular graft were followed- up for 5－ 20 years(mean 10.79 years). Limb function was graded with Enneking s system, and presented as percentage of normal limb function. The changes of the vascularized fibular graft were evaluated radiographically according to the International Symposium on Limb Salvage. Results The long term results of the vascularized fibular graft varied in different types of bone defects. Nine patients with congenital pseudoarthrosis of tibia had the limb function restored in 65％ and one had nonunion of fibular graft, 3 fractures(7 times), and 5 angular deformities. Three patients with congenital radial deficiency had 62％ restoration of the limb function. All of them showed early closure of epiphyses of the grafted fibulae. Five cases with osteomyelitis and bone defects combined soft tissue deficiency had 94％ restoration of the limb function, and only one occurred fracture of fibular graft. One case with soft tissue defect and concomitant ulnar defect, ulnar nerve and median nerve injury, 67％ function of limb was recovered, and union of fibula graft was good. 100％ function of limb was recovered in 1 case with cavernoma of radius and without occurring valgus deformity of donor site. Conclusion The vascularized fibular graft is a good method for repairing long segmental defects of bone. Combined with other tissue flap, the operation can reconstruct bone defect and fulfil the cover of soft tissue. For congenital tibia pseudoarthrosis and radial deficiency, the long- term results are not so satisfactory.

Objective To examine effects of hydrogen peroxide on intracellular free calcium concentration(i) in cardiac myocytes and its antagonism by carvedilol. Methods A cell culture of neonatal rat cardiac myocytes was used for experimentation. They were divided into four groups, i.e. control group, hydrogen peroxide (H 2O 2) group, carvedilol group,and H 2O 2 + carvedilol group. Confocal microscope was used with Fluo-3/AM as calcium indicator to detect changes in i immediately and 15 minutes after H 2O 2 intervention, respectively. Results The intracellular fluoresence intensity of a single cardiae myocyts in the control group and carvedilol group was low. The intracellular fluoresence intensity of a single cardiac myocyte in H 2O 2 group was significantly higher than in the control group 15 minutes after intervention (P

Objective To evaluate the impact of mesoreetal margin micrometastasis on local recurrence of rectal carcinoma after total mesorectal excision, and the relation between mesorectal margin mierometastasis and local recurrence. Methods Mesorectal margin specimens from 52 cases of rectal cancer after total mesorectal excision were studied by reverse transcriptase-polymerse chain reaction (RT-PCR) to detect the expression of CK20 mRNA. These patients were divided into CK20 mRNA positive and negative group and followed up for 3 years until local recurrence developed. Results In 52 patients with rectal cancer,21 cases were found to express CK20 mRNA in mesorectal margin, the expression rate of CK20 mRNA in Dukes A,B and C was 17% ,30% and 54% (P<0.05), respectively. The positive rate of well differentiated, moderately differentiated, poorly differentiated and undifferentiated carcinomas were 43%, 38% ,40% and 50% ,respectively(P>0.05 ). The incidence of local recurrence in CK20 mRNA positive and negative group was 24% and 3% , respectively. The difference was statistically significant between the two groups (P <0.05 ). Conclusion Detection of mesorectal margin CK20 mRNA as micrometastasis by RT-PCR in rectal carcinoma patients was a sensitive and effective way in predicting local recurrence. It is necessary for patients with positive mesorectal margin CK20 mRNA to undergo postoperative radiotherapy after total mesorectal excision.

Since 1970, 13 cases of reconstruction thumb and finger utilizing the second toe were performed. 13 out of 14 reconstructed digits survied with no complication. All wounds healed by primary intention. Emergency reconstruction has the following merits: it is completed in one stage, hence less suffering and economic loss to the patients;it promises early rehabilitation, early return to work and better functional results, as compared with delayed operation. Traumatic amputation of the thumb at or near the metacarpo-phalangeal joint with the transected part so badly injured that replantation is no longer fet-sible, and severe crushing injury of the thumb or all fingers are indicated for emergency reconstruction. Patient's age, occupation, desire for operation and general health should be considered individually before operation. The method of dissecting the second toe with the preservation of vasculization pattern of dorsalis pedis artery-first plantar metatarsal artery should be adopted in case the anatomic pattern of dorsal metatarsal artery belongs to Gilbert type Ⅲ.